隐睾继发恶变15例临床分析

目的回顾性分析15例隐睾继发睾丸癌患者资料,总结隐睾恶变的临床诊治特点.方法分析15例隐睾继发睾丸癌患者资料,年龄21～56岁,平均36.6岁.其中,腹股沟隐睾6例,腹腔隐睾9例;左侧5例,右侧7例,双侧3例.临床分期Ⅰa:4例、Ⅰb:5例、Ⅱb:3例、Ⅱc:2例,Ⅲb:1例.其中,5例已行隐睾牵引复位固定术(双侧1例),复位固定与发现睾丸癌间隔14～26 a,平均22.2 a.结果 6例腹股沟隐睾睾丸癌行根治性切除.9例腹腔隐睾肿瘤中,肿瘤根治性切除6例,根治性切除加腹膜后淋巴结清扫2例,1例因肿瘤严重粘连行姑息切除.病理诊断精原细胞瘤13例,精原细胞瘤合并胚胎癌1例,胚胎癌1例.15例患者中1例行严密监测随访,未行进一步治疗,14例行术后放疗,其中合并胚胎癌者及姑息性肿瘤切除术者同时予以化疗.9例随访6个月～9 a,平均3.7 a,未见复发及远处转移征象.结论隐睾发生肿瘤的概率大于正常睾丸,隐睾应及时治疗并终生随访;隐睾睾丸肿瘤的病理类型多为精原细胞瘤,手术切除加术后放疗疗效较好.

Clinical Analysis of 15 Cases of Secondary Malignant Transformation in Cryptorchid Testes

Objective To analyze data from 15 patients with secondary testicular cancer retrospectively and summarize the diagnostic and therapeutic characteristics of the malignant transformation of cryptorchid testis.Method The data from 15 patients with testicular cancer secondary to cryptorchidism.Their average ages were 36.6 years(ranging from 21 to 56 years),and the patients included 6 cases of inguinal cryptorchid and 9 cases of intraperitoneal cryptorchid.Cryptorchidism occurred on the left in 5 cases,on the right in 7 cases and bilaterally in 3 cases.4 patients presented with stageⅠa,5 with stage Ⅰb,3 with stage Ⅱb,2 with stage Ⅱc,and 1 with Ⅲb.Five of these patients have had the operation of traction reduction(bilaterally in 1),and the time interval between the operation and the testicular cancer occurrence was 14~26 years(the average was 22.2 years).Results All the 15 patients received surgical treatment,including the radical tumor resection of 6 cases of testicular cancer secondary to inguinal cryptorchid,the radical tumor resection of 6 cases among 9 cases with intraperitoneal cryptorchid tumor,the radical tumor resection with retroperitoneal lymphnode dissection(RPLND)of 2 cases,and the palliative operation of 1 patient due to the severe tumor adhesion.The pathological examination showed that 13 cases of them were seminoma,1 case of them was seminoma complicated with embryonic carcinoma,and 1 case of them was embryonic carcinoma.One of 15 cases did not receive the further treatment,and was monitored strictly through a follow-up way.14 cases received the radiotherapy after the surgery,and patients complicated the embryonic carcinoma and having received the palliative operation were given radiotherapy plus chemotherapy.9 patients of them were followed up from 6 months to 9 years with a mean of 3.7years.There was no evidence of tumor recurrence and distant metastasis.Conclusion The risk of malignant change in cryptorchid testes is higher than that of normal testis,we should give a timely treatment and a lifelong follow-up to the patients with cryptorchid.The pathological types of cryptorchid and testis tumor are mostly seminoma and the therapeutic effect of radical operation plus radiotherapy should be better.